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Wednesday, December 4, 2013

1700-1940: "The asthmatic pants into old age."

There is a stunning array of evidence that prior to the 1950s, and even into the 1980s, physicians had a view of asthma as a benign disease; that morbidity (severity) and mortality (the death rate) from asthma was negligible. The evidence comes in the form of quotes from the physicians themselves.

Dr. William Cullen (1710-1790), who wrote extensively on asthma, said:

"The asthma, though often threatening immediate death, seldom occasions it; and many persons have long lived under this disease. In many cases, however, it does prove fatal; sometimes very quickly, and perhaps always at length." (6, page 451)

Dr. William Withering (1741-1799), who recommended the diuretic digitalis for asthma, said:

During the intervals between his attacks the patient probably enjoys fair health, and, as a rule, lives to a good age; should he, however, be cut off prematurely by death; should he, however, be cut off prematurely by death, what do we find as the morbid anatomy to explain the wel marked symptoms seen during life? (16, page 2)

Thorowgood also notes the following:

The prognosis in asthma is generally good, and asthmatics are well known to be, as a rule, long-lived; so that invalids who may have been for some time suffering in the chest are wont to feel much satisfaction and comfort when they are assured that their complaint is " only asthma," or is likely to " turn into asthma." (16, page 35)

Dr. William Aitken, in his book "The Science and Practice of Medicine, said:

Osler also wrote in his 1892 medical textbook "The Principles and Practice of Medicine:

"We have no knowledge of the morbid anatomy of true asthma. Death during the attack is unknown." (8, page 4)

Dr. Anthony Rebuck and Dr. Kenneth R. Chapman said in 1987:

It is now general knowledge that asthma can be fatal and that in some countries with a sophisticated level of medical care the death rates appear to have been increasing. Yet as recently as 1983 an editorialist in the Lancet found it necessary to point out that some physicians still considered the disease "a benign nuisance related mainly to emotional problems" (14, page 353)

Dr. William Osler (1849-1919), the father of modern medicine, said in 1901:

"The asthmatic pants into old age." (4)(7, page 3 and 11)

Dr. Lawrence K. Altman, in the 1990s, said the following:

In 1963, Dr. H.L. Alexander of St. Louis concluded that, prior to 1930, "death during an asthmatic attack was almost unknown."

Altman also said:

"It (this belief) persisted well into this century. A textbook in 1935, for example, said that the life of an asthmatic is not endangered. (8, page 4)

References:

Garrison, Fielding Hudson, "Introduciton to the history of medicine," 1922, London, W.B. Saunders Company

Salter, Henry Hyde, "On Asthma: It's Pathology and Treatment," 1882, New York, William Wood and Company

Altman, Lawrence K., "The Public Perception of Asthma," Chapter one of the book "Fatal Asthma," edited by Albert L. Sheffer, New York, Marcel Dekker, Inc, pages 3 and 11. Lawrence notes the following about this quotation by Osler: "The origin of this statement is obscure. Many authors have said it was one of Osler's aphorisms. However, it is not included in the book of aphorisms." Other notable authors credit the following: William Henry Osler, "Principles and Practice of Medicine," 4th ed, 1901, Pentland, Edinburgh,

Laennec, Rene Theophile Hyacinthe, "A treaties on the diseases of the chest, and on mediate auscultation," tranlated by John Forbes, 1838, New York, Philadelphia, Samuel S. and William Wood, Thomas Cowperthwaite and Company

Ramadge, Francis Hopkins, "Asthma, its species and complications, or researches into pathology or disordered respiration; with remarks on the remedial treatment applicable to each variety; being a practical and theoretical review of this malady, considered in its simple form, and in connection with disease of the heart, catarrh, indigestion, etc." 1835, London, Longman, Rees, Orme, Brown, Green, and Longman

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Wit and Wisdom

History maketh a young man to be old, without either wrinkles or grey hairs; privileging him with the experience of age, without either the infirmities or inconveniences thereof. Yea, it not only maketh things past, present; but enableth one to make a rational conjecture of things to come. For this world affordeth no new accidents, but in the same sense wherein we call it a new moon, which is the old one in another shape; and yet no other than that hath been formerly. Old actions return again, furbished over with some new and different circumstances. (Thomas Fuller in the Epistle Dedicatory to his The History of the Holy War, March 6th, 1639).

About Me

John Bottrell is a respiratory therapist. He's a featured asthma and COPD writer for asthma.net and copd.net. He's the creator and occasionally writer for Respiratory Therapy Cave, the #1 respiratory therapy blog. He's an avid historian and creator of Asthma History. His blog posts have been featured in various newspapers, such as the Chicago Tribune. He has previously been a featured asthma/COPD writer for Healthcentral.com and asthma writer for Answers.com.